Senior Living leadership needs to take a lesson from Mary J. Blige—“No More Drama.” Achieving that goal requires a combination of strong leadership and an empowered staff that won’t stand for complaining within their own teams, says Dennis McIntee, trainer, speaker and author of the book “Eight Qualities of Drama Free Teams.”
No More Drama
For leaders in senior living environments, making these changes involves the ongoing process of learning to improve employee satisfaction, reducing staff turnover and building a team of resilient employees who will adapt to a constantly evolving work environment despite the hard work and lower wages associated with many of their jobs. In his coaching and training initiatives McIntee emphasizes that:
Training is process, not a one-time event
Accountability is important at all levels and
Most workplace constraints are emotional, not logical.
Mining for Gold
When leaders begin looking for strengths in their staff, they find them, even when they’re well below the surface, McIntee believes.
“There is gold inside every person. If you don’t believe that, get out of leadership. Miners have to remove dirt to find gold. You always find what you focus on. It’s there.”
Many of his examples involve the process of managing and empowering lower-paid senior living staff, specifically Certified Nursing Assistants (CNAs). Working under the direction of an RN or LPN/LVNs, CNAs provide hands-on nursing care to patients, residents, clients and customers in a variety of health care settings. Nationwide, turnover among their ranks is high. CNAs typically earn an hourly wage rather than an annual salary, so your pay will fluctuate depending on whether you take a few hours here and there, steadily work full time, or constantly pull 60 hour weeks. According to the BLS, the mean annual wage for medical assistants was $31,220 in May 2014; the median hourly wage was $14.71.
It might look impressive at first, but a paternalistic approach where employees ask lots of questions and leaders habitually “solve” their problems, isn’t strong leadership, McIntee says. Instead, this creates a passive environment where lower-level staffers never learn to think, act and problem-solve on their own. “If you keep giving (ready) answers, they’ll keep having questions. And they won’t think for themselves. We end up with adult-to-child conversations. However, if you believe they’re children (your staff), they’ll continue to act like children,” he says. “Help your people grow up. People respond to how they’re led. For some of us that means we’re going to have to stop blaming our employees.”
Fixing ‘Fat as Texas’
We like to think all of our problems are the result of other peoples’ actions, but that’s not true. Sometimes we have to get angry – at our situations and ourselves – to start making change. McIntee describes a personal process of taking responsibility. Through the years he gained over 60 lbs. and placed the blame for his fat on his wife’s weight gain during her pregnancies with their four children, insisting he was packing on the “baby weight,” even though his wife trimmed down weeks after delivery. “For me it was looking in the mirror and saying, ‘Dennis, you’re fat as Texas, buddy. I had to accept that my weight was the result of my actions. I’d play the victim, until I stepped back and said ‘I gotta take some action.’”
Man (or Woman) in the Mirror
Meanwhile, too many teams get sucked into a Bermuda Triangle of drama, McIntee says. “I see people go into the drama triangle and we lose them forever. They choose to become victims and we never see them again.” But the tough love approach he applied to himself can work in senior housing if leadership is willing to make the first moves.
“If you have drama in your teams, you first have to look at YOU.”
“What have you done to perpetuate the drama? Why does this always happen to me? People who are full of drama believe my events equal my outcome. They believe there’s nothing they can do. As leaders you need to let people know they have all the choice in the world.” He stresses: “When people see they have multiple choices, they take ownership.” Communities that have changed their approach have seen dramatic, positive changes. Sometimes high turnover (especially at first) can be a sign of strong leadership. “They go through CNAs quickly. They (new assistants) show up and realize it’s not the right place for them. And that realization comes from other CNAs; those CNAs go ‘there’s no drama in our community.’” So, new staff accustomed to a high-drama work environment either adapts to their peaceful environment, or move on to a facility where they feel more comfortable. McIntee’s conclusion: “Drama-free work environments are possible. We don’t have to settle.”
6 Takeaways from Dennis McIntee’s “No-Drama” Approach
In drama-free senior living environments, CNAs and other staff maintain a harmonious workspace, either converting whiners to problem solvers or encouraging them to seek employment elsewhere.
Fixing all problems yourself, fixes nothing. Training & empowering a staff that fixes problems, fixes almost everything.
When staffers complain constantly and ask too many questions, 9 times out of 10, it’s leadership’s fault for perpetuating a culture of complaint.
Once your staff knows it has multiple options, they’ll take ownership for their actions.
If you’re overweight, it’s probably your fault. You’re not the victim. If your staff never stops complaining…Have you figured it out by now.
There’s gold in everyone, if you’re willing to dig deep enough. Not willing to make the effort with difficult employees? Get out of leadership.
Lynne Katzmann of Juniper Communities believes coordination with the healthcare world is critical for senior living providers. Indeed, Juniper’s success proves the power of strategic healthcare partnerships. According to Katzmann, the concept of integrated care is the future and will better serve the seniors who rely on our care.
Katzmann’s high-energy talk at the Senior Living Innovation Forum laid out a number of 21st century game changers and how Juniper is helping lead the charge in three capacities.
Technology: Every day could deliver a new data point. According to Katzmann, the deluge of digital data could help improve evidence-based care through analysis. Juniper recognizes the importance of data and requires all healthcare partners to use EHRs (Electronic Healthcare Records). The records have become “table stakes” for healthcare leaders to collect, analyze and manipulate data to better serve patients.
Silver Tsunami: Baby Boomers are coming home to roost…in senior living communities. Currently, someone in America turns 65 every 8 seconds, which means there will be 72.1 million older Americans by 2030. This graying population will have a tremendous impact on resources that by 2022, healthcare will become 20 percent of the country’s GDP–far more than what we can afford. Therefore, Juniper creates and maintains a real-time communication loop with its patients—and their caretakers—through medical concierge services. Not only does this process improve outcomes, but it holds parties accountable for updating records when volume is a variable.
Affordable Care Act: The ACA places value on patient engagement and care transformation, which shakes up the way we relate to our customers. Juniper is finding ways to ensure most post-acute care leaders are rallying around patients in ways that are scalable yet personalized. What does this mean? It means Juniper coordinates networks of providers between patients and doctors to aggregate specific needs in accordance to the law. By finding partners that agree to use our electronic records and communication protocols, the unifying advantage of coordination becomes clear.
At the core of these three areas, Katzmann concluded, “Coordination is key to our strategy of creating and sustaining an environment for senior living.” Simply put, the legwork makes all the difference in helping seniors feel safe and not slip through the system.
How Juniper is coordinating care
Katzmann introduced Juniper’s more formal growth plan to unite a senior’s care network, known as “Connect 4 Life.”
Intentional use of data and outcomes to guide operations, define performance and drive quality.
Integrating primary care practices on-site using a patient-centered medical home model
Cultivating wellbeing through therapy-driven physical wellness programming and seamless access to other services through strategy partnerships and alliances.
The prospect of implementing a new process is enough to make the “old guard” worry about training. Katzmann expressed her team used existing skills to build out “Connect 4 Life” without internal restructuring. It can be inferred that her team was naturally excited to be part of such a groundbreaking strategy that it was built on enthusiasm and trust.
Already, Juniper has seen some fantastic results due to the “Connect 4 Life” model as discharges due to health-related decline decreased by 25%. As the silver tsunami crests crash in from the sea, Juniper won’t run, but rather will be prepared in a storm-resistant shelter to help others.
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Fact: The aging demographic has 70% of the wealth of our country, with two times the discretionary spending of the next generation.
“There has literally never been a better time in the world to do what we’re doing,” says John Cochrane, President and CEO of nonprofit senior living provider Cornerstone Affiliates. At the Senior Living Forum in Napa, Cochrane declared a golden time in the senior care industry. Unlike previous generations of seniors, there is a significant amount of money to be found.
The reason behind this untapped potential is the biggest age wave this world has ever seen. Due to the large cohort of Baby Boomers, some are on the silver end of the spectrum while others have yet to show their first wrinkles. How we age has fundamentally shifted, and this translates into a call to action the industry can’t afford to ignore.
Adapt or Bust
To remain vibrant, vital and relevant moving forward, we must change the current reality that Baby Boomers don’t like us. Yes, the age wave is here to stay…but it’s sort of a tease. Our target audience is growing, but they aren’t easy– they come to retirement communities out of desperation, not desire.
Advances in health care have resulted in the longest life spans in history of the world. In the next 20 years, this unprecedented growth will double the American population aged 65 years or older. RSVP’s for the senior living party should be skyrocketing, yet a negative perception means our audience would rather die alone in their homes than give us a chance.
That’s no exaggeration: 90% of surveyed Baby Boomers outright reject the idea of ever living in a retirement home. Of the 10% who toured senior facilities, 70% disliked what they encountered. That leaves 3% of a marketplace.
So…what about that golden age we were just talking about? This new sophisticated, independent senior demographic isn’t just playing hard to get: these Baby Boomers are declaring they don’t want what we have. In other words, we need to do more than revamp our pick-up lines. Three percent market penetration signals this fact loud and clear.
This is a call for leaders in the field to step up and embrace this time of change. In industries that face disruption, many companies lose their market share out of an inability to adapt. Think Blockbuster’s boot from Netflix, the de-throning of Sear’s by Amazon, and the growing extinction of taxi cabs from their innovative predator: Uber.
So, how do you tap into this innovation? Cochrane and his team devised three simple ways to capitalize on growing existing communities.
1)Understand the business we are in. Yes, we may provide housing for many, but we provide a bigger solution: comfort and care. Defining your channel is a fundamentally fatal risk. What reduces that risk is an adaptable mindset: “We’re in the service of helping people age well, and today we do that with this channel, but tomorrow we may do something different.”
If senior care companies can’t adjust business strategy as needed, newcomers will beat them. As an example, Cochrane cited Ginny Rommety, CEO of IBM, and her take on innovation: “We will need to reinvent ourselves every 5-7 years to stay competitive.” Senior living is no different.
2) Research what the customer wants. Spend time and effort to qualitatively and quantitatively discover what is important to the people you serve. Ineffective surveys can, and should, be replaced by deep dive research. Cochrane cited the rebranding effort of Olay and its successful pivot to anti-aging cream for middle-aged women (instead of their mothers). P&G used volumes of research to identify selling points for a new audience. By taking the time to genuinely understand their customer, it paid off with a multi-billion dollar product line.
Find out what worries the new demographic about aging. When you understand their hopes and dreams in a transformative time where the meaning of aging has shifted, you can truly improve their lives. Create something of value and never stop seeking improvement through research.
3) We need a plan. With enough planning, preparation, training and careful execution, anything is possible. Innovative industry leaders can absolutely overcome the current obstacles, but no one can accomplish this change alone. To gain a competitive edge, we must realize the opportunities right in front of us and capitalize on them by sharing resources with others.
“We don’t have to be all things to all people,” said Cochrane of his company’s approach to operations. Partnerships, connections, and innovations are the key to thriving in this disruptive time.
“You Don’t have to be all things to all people”
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Scott Kaiser believes there’s more to successful senior living than just safety.
“So many of the innovations to making aging better are just big brother,” says the practicing geriatrician and chief innovation officer at the Motion Picture & Television Fund (MPTF).
The problem with the current status of senior living is that the experts trying to improve it are focusing almost exclusively on issues like monitoring and preventing falls and healthcare costs, he says. “People do not want their kids to know every time they open the refrigerator and every time they go to the toilet…after a long life, they’re looking for the next chapter.”
“Purpose is going to become a buzzword,” he predicts.
Nine Decades of Purpose
Scott Kaiser was joined at the recent Senior Living Innovation Forum with a legally blind senior that fully personifies “purpose.”
At 92, Barbara Beskind has had multiple careers – author, art historian, army officer and occupational therapist. An inventor from age eight, she now works as a designer and inventor for IDEO, one of the world’s largest and most distinguished design and innovation consulting firms.
This holder of multiple patents sat down with Kaiser to discuss her work (including how she landed her dream job at 89), the impact of continuing to work and volunteer into our “retirement” years, her thoughts on ways to empower others in her age group and her design for a senior living co-op.
A Second Chance at Inventing
Born in the 1920s, Beskind (nee Knickerbocker) designed her first toy, a rocking horse, at age eight and at 10 announced that she was going to be an inventor. However, like many young women of her era, she was told “no” by both family and the educational system, which didn’t even accept women into engineering programs in those days.
Instead, she focused on home economics and earned a degree in applied art and design before entering the army. She retired as a major in 1966, after 20 years of service and transitioned into a career as an occupational therapist.
IDEO came into her life as she neared her 90s, looking for a fresh challenge.
“In 2013, I saw David Kelley, the founder of IDEO, on ‘60 Minutes,’” she says. Beskind was drawn to IDEO’s diverse team membership that welcomed employees with other background experiences.
“I thought, ‘Oh, that’s for me.”’
So she typed a letter and then “sent it by snail mail, which I think got their attention.” Now she takes the train into San Francisco or Palo Alto every Thursday. “They embrace the idea that everybody’s ideas count. Everybody is decades younger than I am and I’m very proud to be accepted.”
At IDEO, “David Kelly sets the tone. It’s the most exhilarating, egalitarian experience I’ve ever had,” Beskind says. “My experience at IDEO has really been the frosting to my life, such an illuminating and valued experience.”
One takeaway for the other seniors in her community: “I feel that everyone has to have and maintain some specific identity as you age. As you age you have to have a clear identity. My identity is that “She’s the only one that goes to work.”
Building a Better Walker
Putting her occupational therapy and hands-on experience as a senior to use, the ninety-something is helping IDEO innovate the traditional walker.
“For two years I’ve been trying to improve the quality of the walker. The walkers we have are abominable,” she says. “Walkers were designed for rehabilitation and they only incentivize people to lean and lose their balance. If you don’t get off a walker as soon as possible, you’ll lose your automatic gait pattern.”
So she’s designed a walker that allows for vertical handles, which help users maintain normal gait patterns, sustaining the necessary strength in their glutes and hips.
Where Are the Architects?
Inventors have begun embracing the challenges seniors face; Architects, however, have been late getting to the game.
“I want to see good design and I would like to work with architects.”
I think they’ve been remiss (by ignoring senior living). I think they’re out of the loop,” says Beskind, who has taken on the concept herself.
“I have designed a whole co-op of independent living, assisted living and memory care,” says the inventor, whose facility would run on a buddy system pairing up residents with compatible physical and mental challenges to assist each other.
“As someone with low vision, I could help someone with hearing or mobility problems.”
Kaiser and Beskind addressed questions from the audience, including one asking about the role of “senior living operators” in helping people find their identity in terms of work. She refused to blame the system for the perceived lethargy of her peers, adding that perhaps “you should write off this generation and start with those who are 50 or 60 years old and tell them they can be a viable part of society as long as they live.”
She did, however, call to task the approach of many facilities.
“I spent three months in a skilled nursing home (recovering from an injury) and I know what you’re talking about,” she says.
“I think everybody from the CEO down to a busboy should spend 48 hours each year as a patient in whatever level of care they are providing. You only know what it’s like if you’ve been there.”
Senior Living—An Insider’s View
If we allow people to infantilize us, it’s out own fault, in many cases, Beskind says. “Just get out of the place. Develop a community perspective. If your perspective is limited to just your four walls, that’s what you’ll have.”
She adds, “Seniors are the most untapped resource the community has,” urging her fellow residents to be more active socially through volunteering.
“I think we need more opportunities for seniors to be respected for what they bring to the table, but in some cases, we’re our own worst enemies. We need to change the culture completely to bring empowerment to the seniors.”
An easily accessible job-and-volunteer exchange – one that helps match seniors with potential employers and non-profits looking for volunteers – would be a big help in senior communities, she says.
Though it’s hard to find people who have “a depth or continuity of conversation,” in her community, overall Beskind enjoys her friendships with fellow seniors and takes opportunities to help in her community living with cognitive issues to physical challenges.
“I feel that if I can go to bed at night and think that I have had some impact on making another person’s life either safer, more independent or more enjoyable, I feel like a million dollars.”
Her final thought:
“People who have plans live to fulfill them.”
You can view the full session with Scott Kaiser and Barbara Beskind below. To keep up to date on content from the Senior Living Innovation Forum, click the follow button to the right>>
Zeke Turner believes that nursing homes as we know them will cease to exist.
“Like Blockbuster, they’ll be obsolete,” says the founder and CEO of Carmel, Indiana-based Mainstreet, the nation’s largest developer of post-surgical transitional care properties.
Turner, now 38, left Wall Street to found this investment and development firm while still in his mid 20s and in just over a decade he’s created the 21st Century model for transitional care as a standalone offering.
Named an Ernst & Young Entrepreneur of the Year in the real estate design, construction and lodging category, the sometimes-controversial Turner recently shared his thoughts on the transformation of his industry with influence group’s Michael Owens.
Not Afraid to Stir the Pot
Turner gave a brief recap of Mainstreet’s success, as a company that identified and then filled a new niche in healthcare, opting for new construction when existing facilities provided substandard.
“I started looking for better product to buy. We didn’t invent, but uncovered, a new product in transitional care properties.”
Describing many of Mainstreet’s facilities as “like boutique hotels,” Turner says “Transitional Care’s optimal size is somewhere between 70 and 100 units. We’re working on a 50-bed model that can be used in secondary and tertiary markets.”
Better Prep/Shorter Stays
He added that more needs to be done to help seniors prepare for and sometimes even avoid surgical procedures, including strength-building exercises during the months leading up to surgery, a process that will reduce the recovery time patients spend in his transitional facilities.
“Hospitals do a good job of fixing people. They’re expensive, but they do a good job. However, we need to do a better job of keeping people out of hospitals, treating them before they need care. So their rehab stay after the hospital will be shorter because they were stronger going in,” Turner says.
Next Big Thing
In 2015, Mainstreet formed what many consider a surprising partnership with Dr. Bill Thomas, a self-described “nursing home abolitionist.” Turner is getting into the operations side of the business with Mainstreet Health, and Thomas joined the team as director of innovative healthcare.
Dr. Thomas is known as the man behind The Green House Project, in which small groups of seniors live in “homelike settings” enjoying greater autonomy than in nursing homes. Mainstreet is associated with large, often “luxurious” projects, Thomas with non-profits and smaller buildings.
The two have stated that they’ll be working together to bring new models into the marketplace, with Thomas working a project they’re calling TNG: The Next Generation. Turner promises new construction in the very near future. (Bill Thomas gave a provocative keynote at SLIF 2015 which can be viewed here.)
Motivating Staff/Transforming Lives
Though known for the quality of their facilities, Turner insists that recruiting and motivating the best available staff is just as essential—and a constant challenge. “Our mission is to transform lives. Our people show up every day thinking how they can make a difference,” he says.
“We actually track how many lives we have touched and how many jobs we’ve created.”
A big believer in using cognitive tests to show what motivates and energizes staff, to keep staff out of the doldrums, each employee rewrites his or her job description every four years.
“Energy and engagement declines at the four-year mark and we want people to be energized by the job they’re in.”
A Bad Name
Turner says most terms associated with senior living have become tainted, beginning with the word “senior.”
“We want to eliminate terms like ‘senior.’ We know from research that (the term) ‘assisted living’ has an 80% negative connotation to our consumer. They view the term assisted living now like they do nursing home,” he says. “Yet most still include assisted living on their marketing materials.”
The average Mainstreet patient doesn’t even fall within the standard senior demographic.
An Outdated Industry
Prefacing his statement by saying Mainstreet has no plans “to get into assisted living,” assessing the U.S. senior living industry, Turner sees over 15,000 nursing homes serving about two million people, with 35,000 assisted living facilities, about a third of which “are antiquated and need to be repurposed.”
Explaining that the average U.S. nursing home is at least 40 years old, he believes, “The nursing home industry isn’t overbuilt, it’s under-demolished.”
Though outspoken, Mainstreet’s founder isn’t a proponent of a scorched earth policy. “I’m not saying we need to end the existence of every (nursing home) operation in America. There are wonderful people in this system. A lot of people who have great intentions and want to do well,” he says.
“There are operators out there that do a really great job and those that are forward looking will be very successful going forward.”
You can view the full conversation with Zeke Turner below. To keep up to date on content from the Senior Living Innovation Forum, click the follow button>>